Does Medicare Cover Mental Health Care?
Summary: Your mental health is just as critical as your physical health, especially as you age or struggle with other health issues. Medicare usually covers many services, like preventative care, treatment, and hospitalization.
How common are mental health issues in older people?
According to the World Health Organization, mental health conditions plague around 15% of adults over the age of 60. What’s worse is that people at this age can also be battling several health conditions at one time. Treating mental health issues can greatly help your quality of life.
Does Medicare cover mental health?
Original Medicare, Part A and Part B, may cover certain mental health care. It doesn’t cover most prescription drugs you take in your home.
If you have a Medicare Advantage plan, you’ll have at least the same coverage as Original Medicare. Medicare Advantage plans usually cover prescription drugs, and sometimes other benefits besides what Part A and Part B include.
Does Medicare cover mental health hospitalization?
Medicare Part A generally covers inpatient mental health care at a general or psychiatric hospital. Benefits while you’re an inpatient may include:
- Room (usually semi-private)
- Therapy and other treatments
- Lab tests
- Nursing care
- Other services related to treatment
Please note that Medicare rules and restrictions apply. For example, Medicare Part A coverage does not include a private room (unless medically necessary). Part A also won’t generally cover a phone or television in your room, private nursing care, or personal items.
Mental health care and your Medicare Part A out-of-pocket costs
With mental health care and other hospitalizations, Medicare Part A uses benefit periods. A benefit period starts when you’re admitted as an inpatient. It ends when you haven’t had inpatient or skilled nursing care for 60 days in a row. You get as many benefit periods as you need under Part A.
Per benefit period:
- You typically won’t make a copayment for the first 60 days you’re an inpatient under Medicare Part A.
- You pay a copayment for days 61-90.
- For days 91 and beyond, you pay a higher copayment for each lifetime reserve day.
- A Part A deductible applies.
Medicare Part A will generally cover up to 190 days of mental health hospitalization throughout your lifetime.
Mental health benefits under Medicare Part B
Medicare Part B may cover outpatient services and preventative mental health care. For example, Medicare Part B generally covers visits with:
- Psychiatrists or other doctors managing your mental health
- Clinical psychologists
- Clinical social workers
- Physician assistants and nurse practitioners
Part B might also cover preventative mental health screenings, diagnostic tests, and psychiatric evaluations. Once you have a diagnosis, your coverage also may include group and individual therapy, medication management, and family therapy when prescribed as a part of your treatment. When you need more intensive treatment but not full hospitalization, Part B may cover partial hospitalization. That’s an outpatient program where you don’t stay overnight in a hospital.
Prescription drug coverage under Medicare
Sometimes doctors might prescribe drugs to treat mental health conditions. Medicare Part A and Part B have limited prescription drug coverage. You might want to look into prescription drug coverage under Medicare Part D. You can get prescription drug coverage either through a stand-alone Medicare Part D prescription drug plan, or a Medicare Advantage prescription drug plan. These plans are offered by private insurance companies approved by Medicare. Read more about Medicare Part D.
If you enroll in a Medicare prescription drug plan, you may want to be sure your medications are covered. Each plan has its own formulary, which is a list of covered drugs. All plans are required to cover basic medications used for mental health treatment, including antidepressants, antipsychotics, and anticonvulsants. Make sure your specific medications in your plan’s formulary.
Does Medicare cover substance abuse treatment?
Mental health conditions and substance abuse can often go together, according to the Centers for Disease Control and Prevention. When your provider determines you require reasonable and necessary professional treatment for substance abuse, Medicare might cover both outpatient and inpatient care. Coverage may include diagnosis and treatment, patient education, and psychotherapy.
As with mental health services, Medicare Part A may cover hospitalization for substance abuse. Medicare Part B may cover outpatient care at a clinic or hospital. If you are enrolled in a Medicare prescription drug plan, your medications might be covered. Medicare prescription drug plans are required to cover medications necessary to treat substance use disorders.
Find the right plan for you
Your mental health is just as important as your physical health. If you are looking for a Medicare plan option to help with mental health care, our comparison tool is a good place to start. Enter your zip code, follow the prompts and find a plan that works for you.